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E conomic & Social Determinants

E conomic & Social Determinants. Philippa Howden-Chapman He Kainga Oranga/ Housing and Health Research Programme www.healthyhousing.org.nz New Zealand Centre for Sustainable Cities www.sustainablecities.org.nz University of Otago, Wellington. The importance of e mpathy.

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E conomic & Social Determinants

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  1. Economic & Social Determinants Philippa Howden-Chapman He Kainga Oranga/Housing and Health Research Programme www.healthyhousing.org.nz New Zealand Centre for Sustainable Cities www.sustainablecities.org.nz University of Otago, Wellington

  2. The importance of empathy Most respondents in the NZ Values Survey were prepared to pay increased taxes to provide better health services and a better standard of living for the elderly and the disabled. Carroll et al, THE WIDENING GAP, Social Policy Journal, 2011

  3. Waitangi Tribunal: truth, reconciliation, and compensation

  4. Newspeak? • Current HNZ tenants most deprived 5% of households • Healthy Housing Programme • 27% fall in the total number of acute and arranged hospitalisations of year • 61% fall in hospitalisations after crowding reduction • Excluding 55 % of applicants is a faster path to overcrowding, infectious disease (25% of acute hospitalisations) + homelessness • Unfair to reduce small stock of social housing when private rental properties unregulated + • some landlord’s discriminatory ? ? ?

  5. Energy poverty

  6. “Any one who has ever struggled with poverty knows how extremely expensive it is to be poor” James Baldwin, Nobody Knows My Name, 1961.

  7. Built Environment -- Private rental housing stock requirements extremely limited Boarding houses and camping grounds increasingly housing of last resort Insecurity of tenure -> residential mobility -> irregular primary care -> school attendance + +

  8. Evidence-based policies + Government funding– underpinned by research – has led to step change in retrofitting insulation and heaters for home-owners co-benefits: health, education, energy + climate change + Experimentwithmixed-tenure, low carbon urban houses with low operating costs Develop economies of scale + Social Inclusion

  9. Marmot SymposiumAchieving Health Equity Prof Don Matheson

  10. National Goal- Realistic Timeframe in a generation “Achieve Health Equity”

  11. 2030

  12. First nation on earth to achieve health equity The First Nation to Achieve Health Equity The Marmot Cup 2030 New Zealand

  13. All Maori to experience the rights and opportunities it promised.

  14. Replace GDP as the main indicator of societal progress “ GDP Cited in Human Development Report, 2007

  15. Scrap comparisons with Australia as the bench mark for our society’s progress.

  16. Resist marginalisationand ostracism of non conformists.

  17. Free Health Care for Children 24/7 $50

  18. Colonial Views Marmot Symposium, Wellington Wednesday 13th July 2011

  19. Re-Presented

  20. Re-Presented Percentage of the 2006 Population by NZ Deprivation Decile

  21. Re-Presented Source - Hauora IV p38

  22. Re-Presented 1 Eliminating child abuse and neglect VOTE YES It’s a journey not a destination

  23. Re-Presented 2 Eliminate childhood poverty Welfare Working Party Working for Families Father not known Vulnerable

  24. Re-Presented 3 Protect & expand early childhood education Evidence based Cost effective Needs training support Vulnerable

  25. Re-Presented 4 Live gently on our planet Global warming Population size Sustainability Vulnerable

  26. Pacific people in New zealandDebbie Ryan and Ineke MeredithMarmot symposiumWellington13 july 2011

  27. Pacific people in nz 2011 • Pacific peoples constitute 6.9% of NZ population (2006 Census) • 38% Pacific population under 15yr of age • By 2051, NZ student population will rise from 1 in 10 as it is currently to 1 in 5 • Poorer life expectancy • Highest mortality rate for cerebrovascular disease • Mortality rate for cardiovascular disease higher than that for non-Maori non-Pacific People • Diabetes • Obesity • Amenable mortality

  28. Pacific Child Health in NZ • 85% Pacific children completely immunised by age 2 • Highest failure rates new entrant hearing tests • At 5yr of age, only 32% Pacific children caries free • Pacific children aged 5-14yr are 6x more likely to be obese than other children in NZ • Unintended pregnancy and longtermconsequences: poor antenatal care, obstetric complications, low birth weight infants, poor educational attainment and child abuse (The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, 2005) • Rheumatic Fever • Rheumatic Heart Disease • Meningitis • Highest hospitalisations for asthma

  29. Acute rheumatic fever in nz Acute Fever Rheumatic Admissions in 0-24 Year Olds by Ethnicity, New Zealand 1996-2007 Source: New Zealand Child and Youth Epidemiology Service

  30. Serious skin infections Hospital Admissions due to Serious Skin infections in Children and Young People 0-24 years by Ethnicity, New Zealand 1996-2006 Source: New Zealand Child and Youth Epidemiology Service

  31. Avoidable hospitalisations • NZHS 2006: Decreasing unmet need • Pharmaceutical expenditure approximates that expected based on health need • Increasing rates of emergency care self-presentation for less urgent conditions ASH rates per 1000 for Counties Manukau 0-74 year olds, by ethnicity 2001-2009 Pacific Maori non-Maori non-Pacific Source: CMDHB: Changes in Primary Health Care 2001 - 2009

  32. Focus on youth • Disadvantage at different stages of life affects adult health (Power and Kuh 2006) • Are there circumstances which make inequality later in life more likely? • “Although all children gain from quality early childhood education, society benefits most from the investment in children from low-income or disadvantaged homes” (Improving the Transition, May 2011)

  33. A Focus on Reducing inequalities For Pacific Peoples System Response • Legislation NZ Public Health and Disability Act 2000 – “...to reduce health disparities by improving the health outcomes of Maori and other population groups...” • National strategies • New Zealand Health Strategy 2000 • Primary Health Care Strategy 2001 • Public Health • Pacific Health and Disability Action Plan 2002 and Pacific Provider Development Fund • Quality focus • Evidence based guidelines • Primary health care accreditation • Performance management • Research and evaluation • Workforce development

  34. Determinants of health and Empowerment • DHB Pacific community and church based programmes • Enua Ola • LotuMoui • Health Village Action Zones • HEHA • Housing programmes • Anti-smoking • Health prevention- immunisation (MenzB, childhood, Influenza, HPV), cancer screening, early childhood health checks • Pacific unemployment rate in was 4.7%, (3.4%) in December 2007 compared with 26.1% (10.6%) in 1992.

  35. A new approach – understanding “adaptive challenges”

  36. Children Russell Wills FRACP, MPH Community and General Paediatrician, HBDHB Children’s Commissioner

  37. Why should we care about children? • The foundations of adult health are laid in childhood. • Children are vulnerable. • Children are 25% • of our population. • Children have no political power. • Evidence base. • UNCROC.

  38. Lessons and opportunities Big problems require a plan Local solutions to local issues, with national standards • Immunisations, B4SC, FVIP, ASH… • Can reduce inequalities National solutions • PSNZ clinical networks • Annual “State of the Nation’s Children Report” • Scorecard • Green Paper • Difficult choices with uncertain answers • Universal entitlement vs targeted to guarantee needs met? • Parents’ rights vs state’s right to require behaviours? • Engage media to discuss the issues, c.f. conflict • Opinion pieces, public debates & presentations

  39. Heart health equity What prospects? Norman Sharpe

  40. Disproportionate universalism: CVD mortality

  41. An increasing burden for Māori IHD Mortality in NZ Trends and Projections Tobias et al NZMedJ April 2006 For Māori, an actual increase in the absolute number of deaths is projected for males and a relatively stable number for females

  42. Poverty and health risk in New Zealand Cigarette smoking, obesity prevalence and NZ Dep NZ Health Survey 2006-7

  43. Risk Factors for Acute Rheumatic Fever 0-24 years New Zealand 2002-2006 Maori 23 times and Pacific ~50 times more affected Poor Maori (29/100,000) 22.97Pacific (62/100,000) 48.62 European (1.3/100,000) 1.00Asian/Indian (1.3/100,000) 0.99

  44. Life expectancy and health inequalities in NZ Variation amongst DHB areas Smaller health inequalities Otago Waitemata Hutt Tairawhiti Taranaki Cap/Coast N-M MidC Canty Whanganui S Canty Shorter life expectancy Longer life expectancy S’land BoP W Coast Auckland H Bay Waikato Wairarapa “Health inequality” = variation in life expectancy within each DHB’s area. Lakes Counties M Northland Greater health inequalities

  45. Inequality of Access to Health Services Hospital Discharges in 2009 with an Angiography Procedure

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